Going On A Trip And Never Coming Back

Philip Seymour Hoffman’s quick journey from long-term sobriety to relapse to death scares Seth Mnookin, who has struggled with alcohol and heroin addiction:

My first attempt at recovery came in 1991, when I was 19 years old. Almost exactly two years later, I decided to have a drink. Two years after that, I was addicted to heroin. There’s a lot we don’t know about alcoholism and drug addiction, but one thing is clear: Regardless of how much time clean you have, relapsing is always as easy as moving your hand to your mouth.

In response to Hoffman’s death, Sacha Scoblic highlights the shortcomings of twelve-step programs and wonders if another approach could have saved Hoffman:

A big part of the problem is rehab itself, which is almost universally based on twelve-step work, like Alcoholics Anonymous or Narcotics Anonymous. But AA was developed in the 1930s, in the absence of brain science and in the presence of unimaginable stigma. As Anne M. Fletcher writes in her excellent book Inside Rehab, contemporary rehab is still based on “the folk wisdom of recovering people, particularly through the perspectives of Alcoholics Anonymous and related twelve-step programs.” Don’t get me wrong, AA is an incredible program and a true American achievement for the millions of addicts around the world who desperately needed help when absolutely no one else was offering it. I think founder Bill Wilson should be sainted. I, myself, found sobriety in the rooms of AA, where fellowship and rigorous honesty probably saved my life. But AA is not a medical program, and it is not based on science. It is an abstinence-based program that may not be right for every addict. Particularly opiate addicts.

We don’t know what treatments Hoffman received, but it’s unlikely that it was state-of-the-art care rooted in the fact that addiction is a brain disease. He should have received a range of treatments that have been proved to be effective. Traditionally, the only choices offered to addicts were 12-step programs, but proven treatments now include cognitive behavioral therapy, motivational interviewing and psychopharmacology. Indeed, medications are particularly effective in treating opiate addictions. Richard Rawson, associate director of the UCLA Integrated Substance Abuse Programs, says, “Failure to encourage patients to use these medications is unconscionable. It’s comparable to conducting coronary-bypass surgery and failing to prescribe aspirin, lipid and blood-pressure medications as part of a discharge plan.”

Might there be disadvantages to viewing addiction as a brain disease? Stanton Peele, a psychologist who has been writing about addiction for nearly four decades, suggests that the “learned helplessness” inculcated by the disease model makes tragic outcomes like Hoffman’s death more rather than less likely. An addict who believes complete abstinence from heroin is the only acceptable option because he is physiologically incapable of exercising control over his drug consumption may be ill-prepared for a relapse. Having adopted an all-or-nothing view, he may be disinclined to take precautions such as moderating his intake, asking friends to look in on him, having naloxone on hand in case of an overdose, and avoiding other depressants (which are involved in the vast majority of so-called heroin overdoses). In other words, the lack of responsibility that Sheff urges can have deadly consequences.